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송정훈 ( Jung Hoon Song ),허진국 ( Jin Gook Huh ),김유선 ( You Sun Kim ),이진호 ( Jin Ho Lee ),장원철 ( Won Cheol Jang ),옥경선 ( Kyung Sun Ok ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ) 대한장연구학회 2008 Intestinal Research Vol.6 No.2
Background/Aims: Although colonic diverticular disease is less common in Koreans than in Western people, its incidence has been on the increase in Korea. We investigated the clinical characteristics and related complications of colonic diverticular disease in Koreans. Methods: We retrospectively reviewed the medical records of 9,006 patients who underwent colonoscopy at the Seoul Paik hospital between July 2002 and January 2008. Results: Of the 9,006 patients, there were 654 cases (7.3%) of colonic diverticulosis (472 men, 182 women). The mean age of the patients was 54.6±12.0 years. The right colon was involved in 535 cases, the left colon was involved in 86 cases and both the left and right colon was involved in 33 cases. Among the patients, a single diverticulum was seen in 253 cases and two or more diverticuli were seen in 401 cases. Related complications were diverticulitis (11 cases, 1.7%) and diverticular bleeding (3 cases, 0.5%). Conclusions: The incidence of colonic diverticular disease in Korea shows an increasing trend. Colonic diverticular lesions are frequently found in the right colon. (Intest Res 2008;6:110-115)
확장이 없는 총담관 결석의 진단에서 내시경초음파검사의 유용성
이정환 ( Jung Hwan Lee ),김유선 ( You Sun Kim ),류수형 ( Soo Hyung Ryu ),이상렬 ( Sang Ryul Lee ),이수연 ( Su Yeon Lee ),박종혁 ( Jong Hyeok Park ),문정섭 ( Jeong Seop Moon ),김형훈 ( Hyung Hun Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.2
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic Ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation. Methods: A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively. Results: CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications. Conclusions: EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication. (Korean J Gastroenterol 2010;56:97-102)
권민정 ( Min Jung Kwon ),류수형 ( Soo Hyung Ryu ),조수연 ( Soo Yeon Jo ),곽철훈 ( Chul Hoon Kwak ),윤원재 ( Won Jae Yoon ),문정섭 ( Jeong Seop Moon ),이혜경 ( Hye Kyung Lee ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.6
Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva. (Korean J Gastroenterol 2016;68:321-325)
국내 유통 중인 음료식품과 속쓰림과의 관련성에 관한 연구
김영관 ( Young Kwan Kim ),문정섭 ( Jeong Seop Moon ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),김유선 ( You Sun Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.2
목적: 국내에 유통되는 음료식품에 의한 속쓰림 발생의 빈도를 조사하고 음료식품이 속쓰림을 일으키는 기전을 규명하고자 하였다. 대상 및 방법: 2004년 11월부터 2005년 6월까지 속쓰림을 주소로 서울백병원에 내원한 382명의 환자를 대상으로 설문지를 통하여 35종류의 음료식품에 의한 속쓰림의 빈도를 조사하여 점수화하였다. 각 음료의 수소이 온지수, 적정산, 삼투질농도를 측정하여 속쓰림 점수와의 관련성을 검정하였다. 결과: 속쓰림 점수가 가장 높은 음료는 커피(1.15)와 소주(1.12)였으며 가장 낮은 음료는 우롱차(0.17)와 당근주스(0.18)였다. 과실채소음료의 적정산이 속쓰림과 관련성이 있었다(r=0.78; p=0.023). 탄산음료는 가장 낮은 수소이온지수를 보였으나 속쓰림 점수와의 관련성은 없었다(r=?0.54; p=0.460). 주류는 수소이온지수가 높을수록 속쓰림 점수가 높았으며(r=0.84; p=0.037) 삼투질농도와는 역의 관계가 있었다(r=?0.86; p=0.028). 무카페인커피는 일반커피보다 속쓰림 점수가 의미 있게 낮았으며(p<0.001) 일반우유는 저지방우유보다 속쓰림 점수가 더 높게 나타났다(p=0.008). 결론: 이번 논문은 속쓰림을 호소하는 환자들에게 적절한 음료식품을 선택할 수 있도록 정보를 제공하여 치료에 도움을 줄 수 있을 것이다. Background/Aims: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. Methods: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. Results: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=?0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=?0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). Conclusions: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn. (Korean J Gastroenterol 2010;55:109-118)
대장 혈관이형성증에 대한 아르곤 플라즈마 응고 소작술 이후 생긴 자발성 세균성 복막염
정혜진 ( Hye Jin Jung ),류수형 ( Soo Hyung Ryu ),박경식 ( Kyoung Sik Park ),윤원재 ( Won Jae Yoon ),김진남 ( Jin Nam Kim ),김유선 ( You Sun Kim ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.2
Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma. (Korean J Gastroenterol 2014,64:115-118)
직장 카르시노이드 종양에서 Ki-67 발현의 예후적 중요성
홍수민 ( Su Min Hong ),김유선 ( You Sun Kim ),문정섭 ( Jung Seop Moon ),김진남 ( Jin Nam Kim ),오명기 ( Myoung Ki Oh ),권선옥 ( Sun Ok Kwon ),정성연 ( Seong Yeon Jeong ),홍성우 ( Seong Woo Hong ),강윤경 ( Yun Kyung Kang ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2
Background/Aims: Rectal carcinoid tumors can be resected with endoscopy, and it is important to assess their prognostic factors. We evaluated the potential of Ki-67 expression as a prognostic factor in rectal carcinoid tumors. Methods: We retrospectively reviewed the medical records of 37 patients with rectal carcinoid tumors who got endoscopic resection from January 2001 to January 2011 at Inje University Seoul Paik Hospital. We analyzed their endoscopic and histologic findings, Ki-67 expression, clinical outcome, and prognosis. Results: The mean age (±SD) of the patients was 56.3±10.7 years, and the male : female ratio was 3.6:1. The mean tumor size was 0.5±0.4 cm, 33 patients showed grade 1 tumors (89.2%) and the average Ki-67 expression was 0.7±1.2%. Thirty five patients underwent endoscopic mucosal resection, and two required endoscopic submucosal dissection. Eight patients had positive margins after resection, but no cases of lymphovascular invasion were identified. The median follow-up duration was 21.4±25.4 months, and no recurrences were observed. Conclusions: In low grade rectal carcinoid tumors which are lack of central depression on colonoscopy, the expression of a molecular marker of malignant potential, Ki-67, was low. Therefore, endoscopic resection seemed to be a safe and effective treatment for these tumors.
하부위장관 출혈이 발생한 만성 콩팥병 환자의 대장내시경 특징과 임상 양상
이경진 ( Kyung Jin Lee ),구호석 ( Ho Seok Koo ),김유선 ( You Sun Kim ),민정화 ( Jung Hwa Min ),조수연 ( Soo Yeon Jo ),윤원의 ( Won Eui Yoon ),이동훈 ( Dong Hun Lee ),김진영 ( Jin Young Kim ),문정섭 ( Jeong Seop Moon ),고행일 ( Hae 대한내과학회 2019 대한내과학회지 Vol.94 No.4
목적: 만성 콩팥병 환자는 위장관 출혈의 위험성이 높다. 출혈의 원인으로는 요독증으로 인한 혈소판 기능장애, 혈류저하, 항응고제 사용 등이 알려져 있다. 이번 연구에서 하부위장관 출혈을 동반한 만성 콩팥병 환자에서 대장내시경 소견과 임상 양상의 관계를 확인하고자 하였다. 방법: 2003년 1월부터 2016년 8월까지 만성 콩팥병 입원환자 중 하부위장관 출혈이 의심되어 대장내시경을 시행한 230명의 환자를 대상으로 하였다. 만성 콩팥병의 단계와 실제 하부위장관 출혈 여부를 구분하여 대장내시경의 소견과 임상 양상을 비교하였다. 결과: 73명(31.7%)의 환자가 대장내시경 검사에서 실제하부위장관 출혈이 확인되었다. 실제 출혈 환자의 평균 나이는 65.7 ± 12.8세였으며 이 중 52.1% (38명)가 여성이었다. 가장 흔한 하부위장관 출혈의 원인은 치질 출혈(32예, 43.8%) 이었으며 대장 직장 궤양 출혈(21예, 28.8%), 대장 게실 출혈(12예, 16.4%), 대장염에 동반된 출혈(12예, 16.4%), 혈관 형성 이상(12예, 16.4%) 순이었다. 만성 콩팥병이 진행될수록 하부위장관 출혈은 유의하게 증가하였다(p = 0.043). 다중 로지스틱 회귀분석 결과 치질(OR: 4.349, 95% CI: 2.043-9.256, p < 0.001), 대장 직장 궤양(OR: 20.001, 95% CI: 4.780-83.686, p < 0.001), 혈액 투석 여부(OR: 6.863, 95% CI: 1.140-41.308, p = 0.035)가 유의한 상관관계를 보였다. 결론: 만성 콩팥병 환자에서 혈액 투석을 받는 경우 하부위장관 출혈의 위험성이 높았으며 대장내시경 소견 중 치질과 대장 직장 궤양이 가장 유의한 병변이었다. Background/Aims: Patients with chronic kidney disease (CKD) have a high risk of gastrointestinal tract bleeding because of platelet dysfunction attributable to uremia, a poor blood supply, and frequent use of anticoagulant agents. We describe the colonoscopic characteristics of lower gastrointestinal tract bleeding (LGIB) in patients with CKD. Methods: A total of 230 hospitalized patients with CKD who underwent colonoscopy because of suspected LGIB between January 2003 and August 2016 were reviewed retrospectively. We categorized CKD into five stages according to the estimated glomerular filtration rate and compared the colonoscopic findings and clinical manifestations among these five subgroups. Results: Of the 230 patients with CKD suspected of LGIB, 73 (31.7%, 103 cases) were colonoscopically confirmed to exhibit LGIB. Their mean age was 65.7 ± 12.8 years, and 52.1% were female (n = 38). The most common causes of LGIB were hemorrhoidal bleeding (32 cases, 43.8%), followed by bleeding of colorectal ulcers (21 cases, 28.8%), diverticular bleeding (12 cases, 16.4%), colitis-related bleeding (12 cases, 16.4%), and angiodysplastic bleeding (12 cases, 16.4%). As the CKD stage progressed, the incidence of LGIB increased (p = 0.043). On multivariate logistic regression analysis, LGIB was more common in CKD patients with hemorrhoids (odds ratio [OR]: 4.349, 95% confidence interval [CI]: 2.043-9.256, p < 0.001) or colorectal ulcers (OR: 20.001, 95% CI: 4.780-83.686, p < 0.001) and in those on hemodialysis (OR: 6.863, 95% CI: 1.140-41.308, p = 0.035). Conclusions: In CKD patients, the risk of LGIB is significantly increased by hemorrhoids, colorectal ulcers, and a positive hemodialysis status. (Korean J Med 2019;94:362-370)
김형훈 ( Hyung Hun Kim ),김유선 ( You Sun Kim ),옥경선 ( Kyung Sun Ok ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ),이혁상 ( Hyuck Sang Lee ),이혜경 ( Hye Kyung Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient`s abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection. (Korean J Gastroenterol 2010;56:382-386)
명희준 ( Hee Jun Myung ),류수형 ( Soo Hyung Ryu ),유중호 ( Chung Hao Liu ),유정훈 ( Jung Hoon Yoo ),김서현 ( Seo Hyun Kim ),김승혁 ( Seung Hyuk Kim ),윤원의 ( Won Eui Yoon ),박태영 ( Tae Young Park ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.4
The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported. This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky. (Korean J Gastroenterol 2021;77:190-193)